The temporomandibular joint (TMJ) is your jaw joint formed by the mandible, or lower jaw, and the temporal bone of the skull. It is an unique joint because it is a sliding joint and is capable of two types of movement. These movements are rotational, as with other ball and socket joints, and translational - in effect, a forward sliding motion. What also makes it unique is that it is the only bilateral joint in the body.
Located between the two bones is a disc, called the meniscus. It is comprised of cartilage and can absorb impacts and act as a cushion. The meniscus' movements are controlled by muscles. . These are the muscles of mastication (chewing) and are located around the jaw and TMJ. Ligaments are present to hold the two bones together. Articular cartilage covers the surface of the bones and acts to prevent the direct contact of the two bones during movement.
Your neuromuscular dentist will evaluate any tenderness in the muscles which control the movement of the TMJ. Palpation of the muscles from the side of your head above your ear to mid-face, as well as within your mouth, is conducted with a fingertip using firm pressure. Any tenderness or soreness may denote a muscle which is sore and fatigued. The joint itself is then palpated and manipulated in front of your ears to discover any soreness. You will then open and close your jaw as wide as possible. This will allow the evaluation of any popping or grinding of the jaw upon opening and closing and your maximum range of opening. This is repeated with the doctor's fingertip in the external ear canal to discover any displacement or inflammation of the joint.
Finally, your jaw may be gently manipulated through its normal range of motion to evaluate which type of motion causes any symptoms to occur. The proper treatment will be determined from the results of this evaluation.
Questions you can answer to determine if you might have a TMJ disorder:
1. Do you have frequent headaches?
2. Do you hear popping, clicking or cracking sounds when you chew?
3. Do you hear a grating sound (like crumpling of newspaper) when you chew?
4. Do you have stuffiness, pressure or blockage in your ears?
5. Do you hear a ringing or buzzing sound in either or both of your ears?
6. Do you experience dizziness frequently?
7. Do your jaws feel like they "catch?"
8. Do your jaws feel tight, difficult to open?
9. Does it appear that you can't open your mouth as wide as you used to?
10. Does your tongue go between your teeth or do you bite on your tongue to separate your teeth?
11. Do your teeth ache?
12. Are your teeth sensitive, especially to cold temperatures?
13. Do you wake with sore facial muscles?
14. Do you clench or grind your teeth during movements of frustration or concentration?
15. Do you grind your teeth at night?
16. Do your ears hurt?
17. Does it hurt to move your jaw sideways?
18. Do your neck, back of your head, or shoulder hurt?
19. Have you been hit in the jaw?
20. Have you been put to sleep for surgery?
21. Have you had a whiplash injury?
22. Have you seen a neurologist, psychologist or psychiatrist for unexplained head or neck pain?
23. Do your jaws ache after eating?
24. Are you under a lot of stress?
25. Have you been told that you might have a TMJ disorder?
TMJ & TMD
Normal v. Pathological Joints
A pathological temporomandibular joint may occur in a number of ways. Trauma to the joint has been shown to cause a large percentage of the damage. As a result, the ligaments which attach the mandible with the temporal bone can be stretched and torn. This ligament damage may lead to a dislocation of the meniscus and subsequent problematic movement and pain. Dislocation may also cause tearing and rupturing of the meniscus.
Upon opening and closing, the dislocated (displaced) meniscus can return to its normal position for a certain portion of the movement. Popping or clicking upon opening and closing is usually the meniscus returning to position. However, it is only temporary. In instances when the dislocated meniscus does not return to normal position, there will be a limited range of motion. The articular cartilage covering the bone surfaces may also be affected by arthritis. This cartilage may be worn, causing the bones to rub against each other during certain movements, and thereby producing pain. Also, inflammation in the joint associated with arthritis will cause pain.
here are a whole host of conservative TMJ treatment options. The first and foremost is your self-awareness of your grinding or clenching habit (oral stress) that can be controlled during the daytime. Home exercises and physical therapy are an adjunct to the delivery by your dentist of a mouth guard which will help reduce the intensity and frequency of your oral stress and inevitably and subsequently protect your teeth from further wear and destruction. This will restore the muscles of your head and neck area to normal length, function, posture and full range of motion.
TMJ Treatment Options
The following treatments may be used for TMJ conditions:
Occlusal Splint - Also called a night guard, it is designed to protect the teeth from further wear. This also will reduce the severity of grinding at night and allow the muscles to rest. In more severe cases it may need to also be worn all day to allow the TMJs and muscles to rest.
Jaw Rest - You must rest your jaw for it to heal. The occlusal splint will help somewhat but other steps should be taken. You should not chew gum at all, bite your nails, clench your teeth together while awake, or any other non-functional jaw habits (pencil chewing, etc.) Your diet should be fairly soft - you should avoid excessively chewy and crunchy foods during treatment.
Medication - Pain medication can be prescribed. Often, over the counter analgesics such as ibuprofen are enough. Sometimes we will prescribe medicine similar to ibuprofen but a bit stronger. These medications not only relieve pain but reduce inflammation and will also aid in the healing process. Occasionally a mild muscle relaxant may be prescribed. Narcotic medications are not very helpful in treating TMJ and are rarely prescribed.
The most effective drugs for TMJ management include:
1. Non-narcotic analgesic drugs such as acetaminophen (Tylenol).
2. Non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin, Trilisate, ibuprofen, Naproxen and prescription strength NSAIDS.
3. Muscle relaxant drugs such as Carisoprodol (Soma) and Cyclobenzaprine (Flexeril).
4. Tricyclic anti-depressant medications such as Amitriptyline (Elavil), Nortriptyline (Pamelor), and Doxepin (Sinequan).
Moist heat is very helpful for the sore muscles of TMJ. The penetrating moist heat promotes blood flow into the muscle which aids in healing and relaxation of the muscle as well. This increased blood flow also helps analgesic/anti-inflammatory medications into the muscles. A wet washcloth with a hot water bottle will do, or you can purchase moist heating pads if you wish.
Some simple jaw and neck exercises may be recommended, which will help the muscles stretch. A good time to do some of these is in the warm, moist environment of the shower or bath, particularly in the morning and/or before bedtime.
Physical therapy can help relax the muscles, increase joint flexibility, and the like. We can do some simple stretching therapy in the office if needed. If you need more involved therapy you will be referred to a physical therapist.
Emotion and stress plays an important role in TMJ. TMJ may be a sign that you are under stress which you are not quite aware of. Anything that helps you relieve stress is helpful, such as reading, exercising, listening to music, and the like. If the stress is getting to be a bit much, counseling is often helpful in order to learn stress management. Counseling is also recommended if you feel you need help with any emotional problem. It is almost impossible to get relief from TMJ if the underlying emotional issues are not addressed.
Specialists may be needed to optimally treat your case. Opinions and/or treatment may be sought from physicians, oral surgeons, orthodontists, psychotherapists, physical therapists, or prosthodontists. Very severe cases may be referred from the start to a pain center or a dentist whose main focus is the treatment of temporomandibular disorders.
Another method to treat TMJ symptoms is by using an anterior deprogrammer. This device contacts the four lower incisors when you close your mouth, and reduces resistance when the lower jaw moves back and forth. It reduces muscle contraction intensity and allows a musculoskeletally optimal position for your condyle. An anterior deprogrammer is meant for short term use and in emergency situations.
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